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Harvard Health Publications -- Harvard Medical School HEALTHbeat
February 15, 2006

Dear HEALTHbeat subscriber,

Whether you were the star of your high school sports team or captain of the debate team, one thing you may have in common, as you age, are problem knees. This issue of HEALTHbeat discusses how to keep the years of routine wear and tear on your knees from sidelining you. Also in this issue, Celeste Robb-Nicholson, M.D., editor in chief of Harvard Women’s Health Watch, discusses yeast infections after menopause.

Best wishes,
The Editors
The editors of Harvard Health Publications
Harvard Medical School

In This Issue
1 Oh, my aching knees
2 Notable from Harvard Medical School:
* What to do about Erectile
* Menopause: Managing the
   Change of Life
3 Question and Answer with Celeste Robb-Nicholson, M.D.:
Can you still get yeast infections after menopause?

From Harvard Medical School
Knees and Hips: A Troubleshooting Guide to Knee and Hip Pain

Knees and hips must bear your full body weight while allowing for a wide range of motion, making them susceptible to injury and arthritis. This report covers a wide range of knee and hip conditions and describes treatments and preventive strategies. Hip and knee replacement surgeries are also covered in detail.

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1\ Oh, my aching knees

The achy, balky knee: Everyone seems to have one at some time or another. To make sure you know what to do if your knees act up, here are six tips on how to prevent knee problems or treat them while they’re mild.

  1. Stay active. The knee was made to bear weight, but wasn’t designed to go it alone. Strong, flexible leg muscles take a great deal of pressure off this joint. That means exercise is key to healthy knees. And there’s a bonus — exercising your knee causes synovial tissue in the joint to produce synovial fluid, which lubricates the knee and nourishes cartilage.
  2. Easy does it. Take it slowly when starting an exercise program. Too many people try to reform overnight, only to injure themselves or get discouraged when the exercise seems too difficult or boring. They stop and are right back where they started — sitting around getting creaky.
  3. Simple is the solution. You don’t need to buy expensive treadmills or contraptions. To get started, all most people need is a good pair of walking shoes, a level surface (the mall, a high school track, a well-maintained sidewalk), and, the hardest part of all, some willpower.
  4. Walk in water. Especially if you have osteoarthritis, walking in water is a great way to exercise your knee without putting too much weight on it. Chest-high water reduces the weight on your knee by about 75%. Biking also exercises knees — and the quadriceps — without putting weight on them.
  5. Price is right. The traditional recipe for treating a knee that swells up and gets sore is RICE: rest, ice, compression (wrapping it in an elastic bandage, but not too tightly), and elevation (which drains away fluid and blood). Physical therapists have added protection as a first step, so RICE becomes PRICE. Physical therapists can help you identify activities that contribute to the problem and show you ways to avoid injuries in the future.
  6. Do the homework. If you try physical therapy, you’ll probably be put on an exercise program — and get coaching to help you stick with it. Physical therapy works best if the patient follows through by learning the exercises and doing them at home.

Understanding Common Knee Problems

Bursitis. Bursae are thin sacs that pad your joints and bony outcroppings, reducing friction between the movable parts. You can get bursitis from banging your knee or putting pressure on it. Bursitis is best treated with PRICE and pain relievers.

Tendonitis. Tendons attach muscle to bone. They’re designed to move and stretch, but if overused or stretched too far, they become inflamed.

Bursitis and tendonitis feel much the same. But the location of the discomfort is different and bursitis, unlike tendonitis, hurts even when you aren’t moving your knee. The treatment for the flare-ups is the same — PRICE.

Osteoarthritis. Cartilage covers the end of the thighbone (femur) and the back of the kneecap. The two crescent-shaped menisci that provide the padding between your femur and your shinbone are made of fibrocartilage, which is tougher and more rubbery than the hyaline cartilage that covers the ends of bones. When that cartilage starts to break down, pit or decay, the result is osteoarthritis. If pain from osteoarthritis flares up, follow PRICE.

For more information on common knee conditions and treatments and preventive strategies for your knees and hips, order our special health report Knees and Hips: A Troubleshooting Guide to Knee and Hip Pain


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2\ Notable from Harvard Medical School
** What to do about Erectile Dysfunction

In recent years, there’s been nothing short of a revolution in the treatment of erectile dysfunction (formerly known as impotence). Highly effective pills are already on the market, and more are on the way. But oral medications are just part of the story. No one method works for everyone. This report provides a comprehensive review of many causes of erectile dysfunction and the most effective treatment options. It also includes information on sex therapy and involving your partner in treatment.

** Menopause: Managing the Change of Life

Is hormone replacement therapy safe? How can you treat menopausal symptoms without hormones? Are your physical or emotional symptoms due to menopause, aging, or simply to mid-life angst? This comprehensive report delivers the latest evidence regarding menopause treatments along with recommendations for evaluating your risk factors and making an informed choice.

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3\ Q&A: Why am I still getting yeast infections?

Q: I recently developed a vaginal yeast infection — a surprise, because I haven’t had one in many years. Aren’t these infections unusual in postmenopausal women?

A: About 75% of women will have at least one episode of vaginal yeast infection, or vulvovaginal candidiasis, at some point in their lives. Women most likely to develop a yeast infection include those who are pregnant, take oral contraceptives containing high levels of estrogen, or have uncontrolled diabetes, as well as women whose immune systems are suppressed by illness or medications. Certain contraceptive devices (such as sponges, diaphragms, or IUDs), perfumed feminine hygiene sprays or douches, and wearing tight, poorly ventilated clothing and underwear also increase risk.

Though yeast infections are not as common after menopause, they still account for some cases of vaginal inflammation and are more common in women taking hormone therapy. The microorganism Candida albicans is usually responsible. Candida organisms are normally present in the vagina, mouth, and digestive tract. They usually coexist peacefully with bacteria and contribute to a healthful balance of microorganisms. Infection occurs only when there is an overgrowth of Candida.

One cause of yeast overgrowth is the use of antibiotics, which are helpful in treating urinary tract and other infections but can also kill bacteria that help keep yeast under control. It’s common to develop a yeast infection after completing a round of antibiotics.

Symptoms are the same in women of all ages – itching and soreness of the labia and other tissues surrounding the vagina, burning during urination, and pain during sexual intercourse. A white, clumpy vaginal discharge may also be present.

Since Candida is not the only organism that can cause vaginal infection, itching, and discharge, it’s important for a clinician to confirm the diagnosis. Several oral and vaginal treatments are available. The usual first choice is a vaginal cream used daily for three to seven days or a single oral dose of fluconazole (pregnant women should not take oral fluconazole).

Celeste Robb-Nicholson, M.D., is the Editor in Chief of Harvard Women’s Health


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Harvard Medical School publishes authoritative special health reports on a wide range of topics. Each report delivers practical information on diagnosis, treatment, and prevention of major health concerns in clear, easy-to-understand language. For more information on a specific topic, click the appropriate link below:

Alzheimer’s, Arthritis, Bladder, Cholesterol, Depression, Diabetes, Digestion, Energy, Exercise, Eye Disease, Headache, Heart Disease, High Blood Pressure, Memory, Menopause, Prostate, Sexuality, Sleep, Stroke, Vitamins


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Harvard Medical School offers special reports on over 50 health topics. Visit our Web site at to find reports of interest to you and your family.

Copyright 2006 by the President and Fellows of Harvard College.
To view our archive of past HEALTHbeat e-newsletters click here.
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